Cutaneous tumors in pregnancy

Changes in Melanocytic Nevi and Melanoma Associated With Pregnancy: A Scoping Review

Pregnancy is a transformative period characterized by numerous physiological and hormonal changes, including those affecting the skin. Among these changes, alterations in melanocytic nevi and the potential risk of melanoma are areas of significant interest and ambiguity. This scoping review aims to synthesize existing literature on these topics to provide a comprehensive understanding and identify gaps in knowledge. Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews guidelines, a systematic search was conducted; out of 4824 identified articles, 80 met the inclusion criteria. While some studies suggest hormonal influences might accelerate melanocyte growth, others argue that perceived growth is due to mechanical stretching of the skin, and still others found no significant size changes. Pigmentary changes in nevi are more consistently reported, though some researchers advocate viewing them with suspicion until proven benign. The risk of developing pregnancy-associated melanoma is contentious, with some studies proposing that hormonal changes and gestational immunosuppression increase susceptibility, but the evidence remains inconclusive. Prognostic outcomes are equally disputed, with conflicting findings on pregnancy-associated melanoma thickness, recurrence rates, and survival outcomes. We also performed a novel semi-quantitative analysis to assess attitudes on the risk and prognosis of pregnancy-associated melanoma in the literature, demonstrating that authors of narrative reviews are more likely to oppose theories of pregnancy as a trigger for melanoma development or progression than researchers who conducted the primary investigations. These inconsistencies in the literature highlight the need for further research with standardized methodologies and consideration of confounding factors.

Benign skin tumors in older persons: a population-based study

BACKGROUND

Benign skin tumors become more common with advanced age. However, little is known about the etiology of these common lesions. Our objectives were to evaluate the risk factors for seborrheic keratosis, lentigo solaris, cherry angiomas and melanocytic nevi in an elderly population. Our candidate predisposing factors were sex, age, Fitzpatrick skin type, history of outdoor work, life style factors and anthropometric measurements and laboratory tests.

METHODS

In this retrospective cross-sectional study of a large, well-documented cohort, a total body skin examination (TBSE) was performed by dermatologists. The information gathered was augmented with self-reported data. The associations between benign skin tumors and the risk factors analysed with the Chi square test, Fischer exact test and analysis of variance as appropriate.

RESULTS

The study included 552 participants aged between 70 and 93 years. According to the TBSE, benign skin tumors were present in up to 78.7% in certain subsets of participants. Seborrheic keratosis was the most common lesion type, and 15.6% of all cases had > 50 lesions. Seborrheic keratosis were more common in males (p < 0.05), while lentigo solaris and cherry angiomas were more common in females (p < 0.05). A history of outdoor working associated with higher number of lentigo solaris and seborrheic keratosis lesions (p < 0.05). There was an association between lower glycated haemoglobin levels and the presence of multiple cherry angiomas (p < 0.05). Female subjects with multiple cherry angiomas had higher levels of high-density cholesterol and lower triglyceride values than in those with fewer cherry angiomas (p < 0.05 for both). In males, lower mean haemoglobin levels were associated with multiple cherry angiomas (p < 0.05).

CONCLUSIONS

We found sex differences and several new possible etiological factors behind benign skin tumors which, despite being common, remain poorly characterized.

[Dermatologic surgery during pregnancy and lactation]

It may be necessary for patients to undergo (dermato-)surgical procedures during pregnancy or lactation. Often, there are no drug approvals or guidelines in this context. The following article describes the most common dermatologic surgical conditions during pregnancy and lactation, as well as the special therapeutic considerations and risks to be aware of during treatment. Dermatosurgical procedures are subject to strict indications. Most of these procedures can be performed during pregnancy, but the risks to the mother and fetus must be carefully weighed against the disadvantages of nonsurgical therapy. Although surgery can be performed safely in any trimester, the second trimester and immediate postpartum period are optimal. Surgery should not be delayed for melanoma or high-risk skin cancer. Perioperative positioning and choice of analgesics, antiseptics, anesthetics and antibiotics must be considered carefully to avoid risks to the patient, fetus and infant.

Pyogenic Granuloma Diagnosis and Management: A Practical Review

Background

Pyogenic granuloma (PG), or lobular capillary hemangioma, poses a clinical challenge with its uncertain etiology and treatment options. Although the clinical features and prevalence of PGs are well established, definitive evidence-based treatments remain elusive. This practical review aims to illuminate the complexities of PG management by analyzing surgical interventions based on literature analysis.

Methods

A PubMed/Medline search of "pyogenic granuloma" and "surgery" yielded 1171 studies. Inclusion criteria targeted intervention-associated PG complications over 5% and treatment modalities, excluding nonclinical studies and topics unrelated to plastic and reconstructive surgery. Screening involved Oxford level of evidence, patient data extraction, complications, intervention types, success rates, sessions, follow-ups, and treatments.

Results

Thirty-one studies met inclusion criteria. Most studies were retrospective (67.7%). Ten studies satisfied intervention-linked eruptions, primarily oculoplastic, whereas 21 investigated both surgical and nonsurgical treatment modalities. Across interventions, 3579 patients (age: 34.2-85.7 years) were involved. Postsurgical PG complications averaged 15.1% and were treated predominantly with surgical excision, achieving nearly complete resolution. Surgical and nonsurgical treatment studies included 1233 patients (age: 3-46.5 years), demonstrating a 68.2% average resolution after a single session, with surgical excision exhibiting the highest success rate (96.2%) and minimal complications.

Conclusions

This practical review highlights the complexities of managing PG, emphasizing a spectrum of effective treatments and potential postoperative complications. Ophthalmologic procedures showed PG incidences of 9%-24.4%. Surgical excision proved highly effective, surpassing methods like lasers and injectables that exhibited varied success rates requiring multiple treatment sessions. Challenges included study diversity and varying evidence levels, warranting further comparative research for PG management strategies.

Nerve Sheath Myxoma in Pregnancy: A Case Report

Nerve sheath myxoma (NSM) is a rare benign peripheral nerve sheath tumor that affects young adults. NSMs are asymptomatic, slow-growing swellings located in the upper extremities, more rarely in the lower extremities. Given the high risk of recurrence, it is recommended to perform a complete exeresis. To our knowledge, the evolution and management of NMS during pregnancy have not been described yet. We report the first case of recurrent pretibial NSM in a pregnant girl and its follow-up and outcome during and after pregnancy. NSM is difficult to diagnose clinically or using imaging. The final diagnosis remains histopathological. It is known how various types of benign and malignant skin tumors can develop or change during pregnancy. With our case, however, we documented that pregnancy does not affect the growth and evolution of NSM. Given the benign nature of the lesions and their tendency to grow slowly, during pregnancy, follow-up of NSMs can be conducted through ultrasonography and surgical treatment postponed after delivery. Our case highlights the importance of careful monitoring and individualized decision making, especially in rare scenarios such as NSM, where data on the progression of benign lesions are limited. Our case highlights the importance of a careful monitoring and a tailored treatment in rare scenarios such as NSM, where data on the progression of benign lesions are limited. Considering the benign nature of the lesions and their tendency to grow slowly, follow-up of NSMs during pregnancy can be conducted through ultrasonography, and surgical treatment can be postponed after delivery.

Updates on the dermatopathology of pregnancy-associated skin conditions

Pathologists provide valuable input in the dermatological care of pregnant patients in various contexts. This article provides dermatopathology updates on cutaneous changes associated with pregnancy, organized based on the following classification system: physiological skin changes in pregnancy, specific dermatoses of pregnancy, dermatoses modified in pregnancy, and skin neoplasms in pregnancy. Awareness of the impact of pregnancy on the skin by pathologists is important, as this is an opportunity to contribute to diagnostic precision in this patient population.

Dermatofibrosarcoma protuberans in pregnancy: a case series and review of the literature

BACKGROUND

Dermatofibrosarcoma protuberans (DFSP) is a rare cutaneous sarcoma, which has been reported in pregnancy. This case series reports the clinical and histopathological findings of DFSP in pregnancy.

METHODS

Eighteen cases of DFSP, including six unreported cases and 12 cases from the literature, were identified. Age, anatomic location, tumor size, changes in tumor characteristics during pregnancy, histopathological features, and treatment were recorded. Follow-up data, when available, were noted.

RESULTS

The average age of the cohort was 30.6 years (range 19-38). Ten tumors (55.6%) were located on the trunk, four (22.2%) on the head and neck, three (16.7%) on the extremities, and one (5.6%) in the genitalia. Most tumors demonstrated features of conventional DFSP (12/18, 66.7%), while the remaining were identified as DFSP with fibrosarcomatous (FS) change (3/18, 16.7%), atrophic DFSP (2/18, 11.1%), and myxoid DFSP (1/18, 5.6%). Treatment was reported in 17 cases, at least nine of which were treated postpartum. Ten patients were treated with excision, while seven underwent Mohs micrographic surgery. Three patients recurred on follow-up, one with local recurrence and two with distant metastasis.

CONCLUSIONS

DFSP can undergo enlargement or change in size or color in pregnancy, possibly mediated by hormones. While the majority of cases in this series represented conventional DFSP, unusual clinical and histopathological variants were also present. Treatment in most cases can be safely delayed until after delivery, but recurrent or very large tumors may require treatment prepartum. Close monitoring for recurrence or metastasis is advised.

Hormone receptor expression, clinical and histopathological analysis in feline injection site sarcomas

Feline injection site sarcomas (FISS) are aggressive, with high recurrence and rarely metastasising. The objective of this study was to evaluate, by immunohistochemistry, the expression of oestrogen (ER) and progesterone (PR) receptors in FISS and correlate them with clinical and histopathological aspects. This was a retrospective study with 51 cases of FISS. Immunohistochemistry was performed to detect vimentin, ER, PR and Ki67 expression. Clinical, histopathological and immunohistochemical characteristics were predictor variables and the expression of ER and PR were the dependent ones. Twenty-eight (55%) of the 51 FISS cases were female and 23 (45%) male with 10.7 ± 4.2 years and median tumour size of 3 cm (2.0-5.4). The trunk was the most affected site, with 38 cases (84%). Histological grade III was observed in 57% of the cases, considering differentiation score, necrosis and mitotic index. ER expression, positive in 64% of cases, was associated with the mitotic index (P = .05) and degree of pleomorphism (P = .04). PR was not associated with the variables and 63% of cases were negative for this receptor. Thus, ER expression can affect tumour growth. The knowledge on the FISS hormonal expression is important to clarify the pathophysiological mechanisms. Further studies are needed to predict the value of ER expression in the prognosis of FISS.

Melanoma in pregnancy: certainties unborn

Melanoma diagnosed during childbearing period or up to 1 year after delivery is defined as pregnancy-associated melanoma (PAM). There is some evidence that PAM has worse prognosis if compared with melanoma in nonpregnant women, although literature is still inconclusive. Many biological mechanisms could explain this behavior, such as hormonal and immune status, increased lymphangiogenesis but also delay in diagnostic and therapeutic management. If PAM is suspected, a prompt excisional biopsy under local anesthesia can be performed regardless of the gestational period. Conversely, additional staging procedures (such as sentinel lymph node biopsy or imaging) and systemic therapy are still debatable during pregnancy. A multidisciplinary tailored approach should be preferred, together with exhaustive counseling of the mother.